1
|
Hoffmeister JD, Broadfoot CK, Schaen-Heacock NE, Lechner SA, Krasko MN, Nisbet AF, Russell J, Szot J, Glass TJ, Connor NP, Kelm-Nelson CA, Ciucci MR. Vocal and tongue exercise in early to mid-stage Parkinson disease using the Pink1-/- rat. Brain Res 2024; 1837:148958. [PMID: 38685371 PMCID: PMC11166513 DOI: 10.1016/j.brainres.2024.148958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/27/2024] [Accepted: 04/23/2024] [Indexed: 05/02/2024]
Abstract
Vocal and swallowing deficits are common in Parkinson disease (PD). Because these impairments are resistant to dopamine replacement therapies, vocal and lingual exercise are the primary treatment, but not all individuals respond to exercise and neural mechanisms of treatment response are unclear. To explore putative mechanisms, we used the progressive Pink1-/- rat model of early to mid-stage PD and employed vocal and lingual exercises at 6- and 10-months of age in male Pink1-/- and wild type (WT) rats. We hypothesized that vocal and lingual exercise would improve vocal and tongue use dynamics and increase serotonin (5HT) immunoreactivity in related brainstem nuclei. Rats were tested at baseline and after 8 weeks of exercise or sham exercise. At early-stage PD (6 months), vocal exercise resulted in increased call complexity, but did not change intensity, while at mid-stage (10 months), vocal exercise no longer influenced vocalization complexity. Lingual exercise increased tongue force generation and reduced relative optical density of 5HT in the hypoglossal nucleus at both time points. The effects of vocal and lingual exercise at these time points are less robust than in prodromal stages observed in previous work, suggesting that early exercise interventions may yield greater benefit. Future work targeting optimization of exercise at later time points may facilitate clinical translation.
Collapse
Affiliation(s)
- J D Hoffmeister
- University of Minnesota, Dept. of Otolaryngology, 420 Delaware Street SE, Minneapolis, MN 55422, USA; University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA.
| | - C K Broadfoot
- University of South Alabama, Dept. of Speech Pathology and Audiology, 5721 USA Drive N, HAHN 1119, Mobile, AL 36688, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - N E Schaen-Heacock
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - S A Lechner
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - M N Krasko
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - A F Nisbet
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - J Russell
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - J Szot
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - T J Glass
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - N P Connor
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - C A Kelm-Nelson
- University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA.
| | - M R Ciucci
- University of Wisconsin-Madison, Dept. of Communication Sciences and Disorders, 1975 Willow Drive, Madison, WI 53706, USA; University of Wisconsin-Madison, Dept. of Surgery, Div. of Otolaryngology, 1300 University Avenue, 483 Medical Sciences Building, Madison, WI 53706, USA; University of Wisconsin-Madison, Neuroscience Training Program, 9531 WIMR II, 1111 Highland Ave., Madison, WI 53705, USA.
| |
Collapse
|
2
|
Labeit B, Lapa S, Muhle P, Suntrup-Krueger S, Claus I, Gandor F, Ahring S, Oelenberg S, Dziewas R, Warnecke T. Validation of the DIGEST-FEES as a Global Outcome Measure for Pharyngeal Dysphagia in Parkinson's Disease. Dysphagia 2024; 39:697-704. [PMID: 38135841 PMCID: PMC11239722 DOI: 10.1007/s00455-023-10650-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 11/26/2023] [Indexed: 12/24/2023]
Abstract
Flexible Endoscopic Evaluation of Swallowing (FEES) is one of two diagnostic gold standards for pharyngeal dysphagia in Parkinson's disease (PD), however, validated global outcome measures at the patient level are widely lacking. The Dynamic Imaging Grade of Swallowing Toxicity for Flexible Endoscopic Evaluation of Swallowing (DIGEST-FEES) represents such an outcome measure but has been validated primarily for head and neck cancer collectives. The objective of this study was, therefore, to investigate the validity of the DIGEST-FEES in patients with PD. Content validity was evaluated with a modified Delphi expert survey. Subsequently, 66 FEES videos in PD patients were scored with the DIGEST-FEES. Criterion validity was determined using Spearman's correlation coefficient between the DIGEST-FEES and the Penetration-Aspiration Scale (PAS), the Yale-Residue-Rating-Scale, the Functional-Oral-Intake-Scale (FOIS), and the swallowing-related Unified-Parkinson-Disease-Rating-Scale (UPDRS) items. Inter-rater reliability was determined using 10 randomly selected FEES-videos examined by a second rater. As a result, the overall DIGEST-FEES-rating exhibited significant correlations with the Yale-Valleculae-Residue-Scale (r = 0.84; p < 0.001), the Yale-Pyriform-Sinus-Residue-Scale (r = 0.70; p < 0.001), the FOIS (r = - 0.55, p < 0.001), and the UPDRS-Swallowing-Item-Score (r = 0.42, p < 0.001). Further, the DIGEST-FEES-safety subscore correlated with the PAS (r = 0.63, p < 0.001). Inter-rater reliability was high for the overall DIGEST-FEES rating (quadratic weighted kappa of 0.82). Therefore, DIGEST-FEES is a valid and reliable score to evaluate overall pharyngeal dysphagia severity in PD. Nevertheless, the modified Delphi survey identified domains where DIGEST-FEES may need to be specifically adapted to PD or neurological collectives in the future.
Collapse
Affiliation(s)
- Bendix Labeit
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Sriramya Lapa
- Department of Neurology, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Sonja Suntrup-Krueger
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Inga Claus
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Florin Gandor
- Movement Disorders Clinic, Beelitz-Heilstätten, Germany
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany
| | - Sigrid Ahring
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Stephan Oelenberg
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Rainer Dziewas
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic Teaching Hospital of the WWU Muenster, Osnabrueck, Germany
| | - Tobias Warnecke
- Department of Neurology and Neurorehabilitation, Klinikum Osnabrueck - Academic Teaching Hospital of the WWU Muenster, Osnabrueck, Germany
| |
Collapse
|
3
|
Battista P, Aresta S, Tagliente S, Merlo F, Mongelli D, Lagravinese G, Falcone R, Palmirotta C, Turi G, Castellari M, Zonno A, Gelao C, Picciola E, Fiore P, Battel I, Minafra B. Exploring the Neuropsychological Correlates of Swallowing Disorders in People with Parkinson's Disease: a Cross-Sectional Study. Dysphagia 2024:10.1007/s00455-024-10728-9. [PMID: 38951235 DOI: 10.1007/s00455-024-10728-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 06/10/2024] [Indexed: 07/03/2024]
Abstract
Around 80% of persons with Parkinson's disease (PD) present symptoms of dysphagia. Although cognitive impairment may contribute to dysphagia, few studies have investigated the association between the PD neuropsychological profile and objective measures of swallowing dysfunction. Since the swallowing function comprises involuntary but also voluntary actions, we hypothesize that specific measures of attention and executive functions can be underlined in PD-related dysphagia. Therefore, the aim of this study was to extensively investigate the correlation and the relationship between attentive and executive functions and safety/efficiency of pharyngeal phase of swallowing in people with PD. All participants received a fiberoptic endoscopic evaluation of swallowing and were evaluated using the Penetration Aspiration Scale (PAS); the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS), and the Functional Oral Intake Scale (FOIS-IT). Participants also underwent a neuropsychological assessment covering global cognitive status, attention, and frontal executive functions. Correlations and associations between neuropsychological measures and swallowing components were calculated. Twenty-one participants with PD (mean age 69.38 ± 6.58 years, mean disease duration 8.38 ± 5.31 years; mean MDS-UPDRS III 43.95 ± 24.18) completed all evaluations. The most significant correlations were found between attentive functions (i.e., Stroop Time), and executive functions (i.e., Raven's Progressive Matrices, Digit Backward and Semantic Fluency), and FOIS-IT, PAS, and IT-YPRSRS sinuses and valleculae. These associations were not influenced by disease duration. These results suggest that a dysfunction to attentional processes and/or to executive functions can contribute to penetration and the presence of pharyngeal residue in participants with middle-stage PD.
Collapse
Affiliation(s)
- Petronilla Battista
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy.
| | - Simona Aresta
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit , Institute of Bari, Bari, Italy
| | - Serena Tagliente
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | | | - Davide Mongelli
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | - Gianvito Lagravinese
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | - Rosanna Falcone
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | - Cinzia Palmirotta
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | - Gilda Turi
- Istituti Clinici Scientifici Maugeri IRCCS, Laboratory of Neuropsychology, Institute of Bari, Bari, Italy
| | - Micol Castellari
- Department of Physical and Rehabilitation Medicine, University of Foggia, Foggia, Italy
| | - Alessandra Zonno
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit , Institute of Bari, Bari, Italy
| | - Christian Gelao
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit , Institute of Bari, Bari, Italy
| | - Emilia Picciola
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit , Institute of Bari, Bari, Italy
| | - Pietro Fiore
- Department of Physical and Rehabilitation Medicine, University of Foggia, Foggia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit, Institute of Milan, Milan, Italy
| | - Irene Battel
- Department of Biomedical, Surgical and Dental Sciences, University "La Statale", Milan, Italy
| | - Brigida Minafra
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Unit , Institute of Bari, Bari, Italy
| |
Collapse
|
4
|
Bartlett RS, Walters AS, Wayment HA. Psychosocial Experiences Associated with Dysphagia and Relevant Clinical Implications Among Adults with Parkinson Disease. Dysphagia 2024:10.1007/s00455-024-10722-1. [PMID: 38839625 DOI: 10.1007/s00455-024-10722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
Although the psychosocial sequelae of living with dysphagia secondary to Parkinson disease (PD) are described in the literature as challenging, there has been little focus on using this information to influence the design of dysphagia treatment. A more nuanced understanding of the psychosocial experiences of this population may assist clinicians in providing a patient-centered approach to care. Our study was designed to gather insight into the common psychosocial experiences associated with dysphagia in the context of PD. A semi-structured interview consisting of open- and closed items was conducted with 25 individuals from regions across the country with self-reported oropharyngeal dysphagia secondary to PD. Questions were developed using comprehensive stress and coping frameworks that emphasized psychosocial predictors of specific affective reactions (e.g., grief, anxiety, depression), including self-evaluation (e.g., self-identity), coping strategies, social support, personal expectations (including perceived control over symptoms and prognosis), positive experiences, and perceptions of personal growth. Interview responses were subjected to a qualitative analysis and revealed three dominant themes: (1) Recalibration of a PD Diagnosis, (2) Vigilant Caution to Swallowing, and (3) Grieving the Loss of the Communal Meal. Using these data interpretations, we discuss three concepts for speech-language pathologists working with individuals with dysphagia and PD to consider during clinical interactions; these are reframing swallowing vigilance to engagement with mindful eating, using biofeedback to align patient perceptions and swallow physiology, and understanding the consequences of loss (of their former swallowing ability) through grief and growth reactions.
Collapse
Affiliation(s)
- Rebecca S Bartlett
- Department of Communication Sciences and Disorders, Northern Arizona University, Rm 313 208 E. Pine Knoll Drive, Flagstaff, AZ, 86011, USA.
| | - Andrew S Walters
- Department of Psychological Sciences, Northern Arizona University, Rm 323, Flagstaff, USA
| | - Heidi A Wayment
- Department of Psychological Sciences, Northern Arizona University, Rm 323, Flagstaff, USA
| |
Collapse
|
5
|
Gilheaney Ó, Hussey J, McTiernan K. The lived experiences of oropharyngeal dysphagia in adults living with fibromyalgia. Health Expect 2024; 27:e13932. [PMID: 38062671 PMCID: PMC10757215 DOI: 10.1111/hex.13932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/01/2024] Open
Abstract
BACKGROUND Fibromyalgia is a chronic pain condition which has recently been linked with eating, drinking and swallowing difficulties (dysphagia). However, to date, sample sizes within completed research are small and study designs heterogeneous, and therefore, little is known about the lived experiences of dysphagia among people with fibromyalgia. To go some way towards addressing this gap in the literature, this study collected and analysed the first-hand experiences of the physical symptoms, the psychosocial impacts and environmental factors that influenced the lived experience of a sample of people living with fibromyalgia-associated dysphagia. METHODS Qualitative semi-structured interviews were conducted with adults with dysphagia and fibromyalgia. Reflexive thematic analysis was employed and themes were identified regarding the reported experience and impact of swallowing problems. The same researcher conducted the interviews and extracted all data, and a second researcher analysed a random sample of 5% of the data for accuracy, with no disagreements arising between the two researchers. RESULTS All participants (n = 8) reported the negative psychosocial impact of their dysphagia. Participants reported managing their dysphagia independently, primarily using compensatory strategies. Participants discussed feeling unsupported in healthcare interactions due to clinicians not understanding the occurrence, nature or impact of eating, drinking and swallowing difficulties. Participants also reported that they did not have access to evidence-based management strategies that adequately addressed their fibromyalgia-related swallowing problems. CONCLUSIONS Despite minimal previous research in this area, findings here highlight the impact that dysphagia has on people with fibromyalgia. A broad range of physical symptoms were reported to have negative consequences across both social and emotional domains. The reported symptoms often required complex coping strategies and sometimes impeded participants from seeking suitable medical intervention from healthcare providers. There are both broad-ranging implications of fibromyalgia-associated dysphagia and reported poor perceptions of medical interactions for this cohort of patients. Therefore, there is evidently a need for clinical research into the management of this condition to develop patient-centred care delivery options and to equip healthcare professionals with the knowledge and skills necessary to provide efficacious management to this group. PATIENT OR PUBLIC CONTRIBUTION Before initiation of the qualitative interviews, the interview schedule was piloted with an individual living with fibromyalgia and dysphagia, with feedback provided on the appropriate wording and format of semi-structured questioning.
Collapse
Affiliation(s)
- Órla Gilheaney
- Department of Clinical Speech and Language StudiesTrinity College DublinDublinIreland
- Present address:
Assistant Professor, Trinity College DublinDublinIreland
| | - Joeann Hussey
- School of Linguistic, Speech, and Communication SciencesTrinity College DublinDublinIreland
| | - Kathleen McTiernan
- School of Linguistic, Speech, and Communication SciencesTrinity College DublinDublinIreland
| |
Collapse
|
6
|
Hirschwald J, Finnegan L, Hofacker J, Walshe M. Underserved groups in dysphagia intervention trials in Parkinson's disease: A scoping review. Ageing Res Rev 2024; 93:102150. [PMID: 38043779 DOI: 10.1016/j.arr.2023.102150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Underserved groups in Parkinson's disease (PD) intervention studies are well recognised. However, it remains unclear whether these exclusions apply to oropharyngeal dysphagia (OD) intervention studies in PD. The aim of this scoping review was to identify characteristics of included participants and underserved groups in intervention studies in OD in PD. METHODS Six electronic databases and one trial registry were searched without language restrictions. Screening of studies and data extraction were independently conducted by four reviewers. RESULTS Of the 26 studies included, none fully reported the participants' ethnicity. Where data was available, 70% of participants were male with a mean age of 68 years, mean PD duration of 7.26 years, median Hoehn and Yahr stage of 2.5, mild OD and mostly recruited from movement disorders clinics. Underserved groups were younger people (< 50 years), older people (≥ 80 years), women, non-white people, people with severe OD and PD, longer PD duration, other neurological conditions, cognitive impairment/dementia, and depression. CONCLUSIONS Careful consideration of all characteristics of individuals with OD in PD is essential for improving the external validity of studies. This will enhance the generalisability of research findings to the broader PD population, ultimately strengthening the evidence base for OD interventions in PD.
Collapse
Affiliation(s)
- Julia Hirschwald
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland.
| | - Lauren Finnegan
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
| | - Jule Hofacker
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
| | - Margaret Walshe
- Department of Clinical Speech and Language Studies, Trinity College Dublin, Ireland
| |
Collapse
|
7
|
Nachalon Y, Nativ-Zeltzer N, Dhar SI, Cates DJ, Leon IW, Evangelista LM, Belafsky PC. Partners of persons with severe swallowing dysfunction have significantly reduced mental health. Support Care Cancer 2023; 31:519. [PMID: 37578591 DOI: 10.1007/s00520-023-07991-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 08/09/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Dysphagia can result in malnutrition, dehydration, social isolation, depression, pneumonia, pulmonary abscess, and death. The effect of dysphagia on the health and quality of life (QOL) of the life partners of persons with dysphagia is uncertain. We hypothesize that the partners of individuals with significant dysphagia will experience a significant reduction in quality of life. PURPOSE To evaluate the QOL of the significant others of persons with swallowing dysfunction. METHODOLOGY Persons with significant swallowing dysfunction (defined as EAT10® > 10) and their significant others were prospectively administered the 10-item Eating Assessment Tool (EAT10®) patient-reported outcome measure and the 12-item SF quality of life instrument (SF12). Summary data from the 8 mean health domains were compared between patients and their significant others. Mean scores for each domain are calibrated at 50, and a score below 47 implies significantly diminished QOL for a particular domain. RESULTS Twenty-three couples were evaluated. The mean ± SD EAT10 score for persons with significant dysphagia was 21 ± 7; mean EAT10 for their significant others or for couples in the control group was 0.3 ± 0.8. The mean physical health composite score (PCS) was significantly lower for patients with dysphagia compared to their significant others (39.1 ± 10 and 46.2 ± 11, respectively) (p < 0.05). Both patients and their significant others had comparable mean mental health composite scores (MCS) of 46.6 ± 10 and 46.4 ± 10, respectively (p > 0.05). CONCLUSION Although significant others of persons with swallowing dysfunction have higher physical well-being than their partners, they exhibit the same reduction in mental well-being, which is significantly lower than the general population. The data suggest that clinicians should address the mental well-being of the partners of persons with severe swallowing dysfunction.
Collapse
Affiliation(s)
- Yuval Nachalon
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA.
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Nogah Nativ-Zeltzer
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shumon I Dhar
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Daniel J Cates
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Isabella W Leon
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Lisa M Evangelista
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
| | - Peter C Belafsky
- Center for Voice and Swallowing, Department of Otolaryngology-Head and Neck Surgery, University of California Davis, Suite 7200, 2521 Stockton Blvd, Sacramento, CA, 95817, USA
| |
Collapse
|
8
|
Rudisch DM, Krasko MN, Burdick R, Broadfoot CK, Rogus-Pulia N, Ciucci MR. Dysphagia in Parkinson Disease: Part I - Pathophysiology and Diagnostic Practices. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023; 11:176-187. [PMID: 37608845 PMCID: PMC10441627 DOI: 10.1007/s40141-023-00392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/30/2023]
Abstract
Purpose of Review Dysphagia affects the majority of individuals with Parkinson disease (PD) and is not typically diagnosed until later in disease progression. This review will cover the current understanding of PD pathophysiology, and provides an overview of dysphagia in PD including diagnostic practices, gaps in knowledge, and future directions. Recent Findings Many non-motor and other motor signs of PD appear in the prodrome prior to the manifestation of hall- mark signs and diagnosis. While dysphagia often presents already in the prodrome, it is not routinely addressed in standard neurology examinations. Summary Dysphagia in PD can result in compromised efficiency and safety of swallowing, which significantly contributes to malnutrition and dehydration, decrease quality of life, and increase mortality. The heterogeneous clinical presentation of PD complicates diagnostic procedures which often leads to delayed treatment. Research has advanced our knowledge of mechanisms underlying PD, but dysphagia is still largely understudied, especially in the prodromal stage.
Collapse
Affiliation(s)
- Denis Michael Rudisch
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Maryann N Krasko
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
| | - Ryan Burdick
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Courtney K Broadfoot
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Nicole Rogus-Pulia
- Department of Medicine, Division of Geriatrics and Gerontology, School of Medicine and Public Health, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705, USA
- Geriatric Research Education and Clinical Center, William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
| | - Michelle R Ciucci
- Department of Surgery, Division of Otolaryngology-Head & Neck Surgery, University of Wisconsin-Madison, 1300 University Ave, Madison, WI 53706, USA
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, 1975 Willow Drive, Madison, WI 53706, USA
- Neuroscience Training Program, University of Wisconsin-Madison, 1111 Highland Ave, Madison, WI 53705, USA
| |
Collapse
|
9
|
Güner M, Baş AO, Ceylan S, Kahyaoğlu Z, Çöteli S, Ünsal P, Çavuşoğlu Ç, Özsürekci C, Doğu BB, Cankurtaran M, Halil MG. Dysphagia is closely related to frailty in mild-to-moderate Alzheimer's disease. BMC Geriatr 2023; 23:304. [PMID: 37198547 DOI: 10.1186/s12877-023-04020-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 05/05/2023] [Indexed: 05/19/2023] Open
Abstract
INTRODUCTION Physical phenotype and the cumulative deficit model are two well-known concepts of frailty. One of the main components of frailty is loss of muscle mass and function, which may also include swallowing muscles, therefore is a risk factor for dysphagia. Since dysphagia is seen starting from the early stages of Alzheimer's Disease (AD), in this study we aimed to reveal the relationship between frailty and dysphagia and dysphagia-related quality of life through Swallow Quality of Life (SwalQoL) tool in patients with AD and compare them with cognitively intact older adults. METHODS Comprehensive geriatric assessment, dysphagia evaluation by Eating-Assessment Tool (EAT-10) and SwalQoL questionnaire, and frailty assessment via FRAIL and Clinical Frailty Scale (CFS) were performed on all 101 participants of the study. Thirty-five patients were cognitively intact, 36 patients were diagnosed with mild AD, and 30 patients were diagnosed with moderate AD. RESULTS Sex distribution was similar between the groups, however, there was a statistically significant age difference. The prevalence of frailty increased according to both frailty indexes as the cognitive status deteriorated. All parameters of SwalQoL except fear and sleep parameters deteriorated as cognitive status impaired. In quantile regression of the total score of the SwalQoL questionnaire and multivariable logistic regression of EAT-10, frailty, as defined by CFS and FRAIL, was associated with dysphagia and poor quality of life regardless of age, presence of dementia, as well as nutritional status. CONCLUSION Swallowing difficulties in AD negatively affects the quality of life, and it is closely related to frailty in mild-to-moderate AD.
Collapse
Affiliation(s)
- Merve Güner
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, 06280, Turkey.
| | - Arzu Okyar Baş
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, 06280, Turkey
| | - Serdar Ceylan
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, 06280, Turkey
| | - Zeynep Kahyaoğlu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, 06280, Turkey
| | - Süheyla Çöteli
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, 06280, Turkey
| | - Pelin Ünsal
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, 06280, Turkey
| | - Çağatay Çavuşoğlu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, 06280, Turkey
| | - Cemile Özsürekci
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, 06280, Turkey
| | - Burcu Balam Doğu
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, 06280, Turkey
| | - Mustafa Cankurtaran
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, 06280, Turkey
| | - Meltem Gülhan Halil
- Faculty of Medicine, Department of Internal Medicine, Division of Geriatrics, Hacettepe University, Ankara, 06280, Turkey
| |
Collapse
|
10
|
Plaza E, Busanello-Stella AR. Tongue strength and clinical correlations in Parkinson's disease. J Oral Rehabil 2023; 50:300-307. [PMID: 36681882 DOI: 10.1111/joor.13417] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/10/2022] [Accepted: 01/13/2023] [Indexed: 01/23/2023]
Abstract
BACKGROUND Individuals with Parkinson's disease present affected lingual functioning at some stage of the progression of the disease. The objective was to determine the strength and endurance values of the tongue in PD subjects and whether weakness in tongue lift may be an indicator of disease progression. OBJECTIVE To determine the strength and endurance values of the tongue in PD subjects and whether weakness in tongue lift may be an indicator of disease progression. METHODS Sixty subjects performed tasks of tongue to palate maximum isometric pressure (MIP) and sustained 50% of MIP for endurance. The Iowa Oral Performance Instrument was used as evaluation tool. Selected domains of the Swallowing Quality of Life Questionnaire (SWAL-QOL) related to tongue pressure were considered. Variables of sex, age, disease duration, disease progression (Hoehn & Yahr stage) and body mass index were selected for association analysis. RESULTS Tongue MIP ranged from 16 to 48 kPa (mean = 33.43 kPa), which was significantly lower than normal reference values. Likewise, tongue endurance was significantly diminished. Analysis of variance showed differences in tongue strength between stages of disease progression F(3) = 6.503, p = .001, but not for endurance. Subjects in stage IV exhibited the lowest values. No sex effect was found. Tongue strength showed significant correlations with SWAL-QOL domains such as food selection, symptoms frequency and eating duration. CONCLUSION Tongue strength and endurance are significantly reduced in Parkinson's disease. Tongue strength is higher in the early stage of the disease and significantly different from that of more severe stages, emerging the notion that tongue strength is a sensitive indicator of disease progression. Selected items regarding swallowing quality of life are strongly associated with tongue strength.
Collapse
Affiliation(s)
- Exequiel Plaza
- Department of Speech-Language Pathology and Audiology, Universidad de Talca, Talca, Chile
| | | |
Collapse
|
11
|
Clinicopathological characterization of children with dysphagia, family impact and health-related quality of life of their caregivers. An Pediatr (Barc) 2022; 96:431-440. [DOI: 10.1016/j.anpede.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/14/2021] [Indexed: 11/20/2022] Open
|
12
|
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer's disease and affects about 1% of the population over the age of 60 years in industrialised countries. The aim of this review is to examine nutrition in PD across three domains: dietary intake and the development of PD; whole body metabolism in PD and the effects of PD symptoms and treatment on nutritional status. In most cases, PD is believed to be caused by a combination of genetic and environmental factors and although there has been much research in the area, evidence suggests that poor dietary intake is not a risk factor for the development of PD. The evidence about body weight changes in both the prodromal and symptomatic phases of PD is inconclusive and is confounded by many factors. Malnutrition in PD has been documented as has sarcopaenia, although the prevalence of the latter remains uncertain due to a lack of consensus in the definition of sarcopaenia. PD symptoms, including those which are gastrointestinal and non-gastrointestinal, are known to adversely affect nutritional status. Similarly, PD treatments can cause nausea, vomiting and constipation, all of which can adversely affect nutritional status. Given that the prevalence of PD will increase as the population ages, it is important to understand the interplay between PD, comorbidities and nutritional status. Further research may contribute to the development of interventional strategies to improve symptoms, augment care and importantly, enhance the quality of life for patients living with this complex neurodegenerative disease.
Collapse
|
13
|
A New Therapeutic Approach for Dystussia and Atussia in Neurogenic Dysphagia: Effect of Aerosolized Capsaicin on Peak Cough Flow. Dysphagia 2022; 37:1814-1821. [PMID: 35430718 PMCID: PMC9643184 DOI: 10.1007/s00455-022-10439-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 03/28/2022] [Indexed: 12/16/2022]
Abstract
Swallowing and cough are crucial components of airway protection. In patients with neurogenic dysphagia (ND), there is a high prevalence of dystussia (impaired cough) and atussia (absence of cough). As a result, the ability to detect and remove aspirated material from the airway decreases, exacerbating the sequelae associated with ND, including aspiration pneumonia, a leading cause of mortality in ND. This controlled intervention study aimed to quantify the cough response to aerosolized capsaicin (AC) in patients with ND and assess the potential of AC as a therapeutic tool in treating ND-related dystussia and atussia. Furthermore, we propose a novel application method that enables AC treatment to be performed at home. Spirometry was used to measure peak cough flow (PCF) of voluntary cough (cough on command) and reflexive cough (cough secondary to pharyngeal exposure to AC) in 30 subjects with and 30 without ND. The capsaicin aerosol was generated by adding 1-10 drops of liquid cayenne extract (1.5-2% capsaicin) to 100 mL carbonated water (0.00075-0.001% to 0.0075-0.01% capsaicin). Voluntary PCF in the ND group was significantly lower than in the control group (p < 0.001), while there was no significant difference in reflexive PCF (p = 0.225). Within the ND group, reflexive PCF was significantly higher than voluntary PCF (p = 0.001), while in healthy controls, reflexive PCF was significantly lower (p < 0.001). The data show that AC increased the tracheobronchial clearance efficacy in ND patients with dystussia and atussia, as it enabled subjects to access their individual cough potential, which is present, but inaccessible, due to neurological disorder.
Collapse
|
14
|
A multinational consensus on dysphagia in Parkinson's disease: screening, diagnosis and prognostic value. J Neurol 2021; 269:1335-1352. [PMID: 34417870 PMCID: PMC8857094 DOI: 10.1007/s00415-021-10739-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/01/2021] [Accepted: 08/02/2021] [Indexed: 11/25/2022]
Abstract
Background Parkinson’s disease (PD) is a neurodegenerative disorder characterized by a combination of motor and non-motor dysfunction. Dysphagia is a common symptom in PD, though it is still too frequently underdiagnosed. Consensus is lacking on screening, diagnosis, and prognosis of dysphagia in PD.
Objective To systematically review the literature and to define consensus statements on the screening and the diagnosis of dysphagia in PD, as well as on the impact of dysphagia on the prognosis and quality of life (QoL) of PD patients.
Methods A multinational group of experts in the field of neurogenic dysphagia and/or PD conducted a systematic revision of the literature published since January 1990 to February 2021 and reported the results according to PRISMA guidelines. The output of the research was then analyzed and discussed in a consensus conference convened in Pavia, Italy, where the consensus statements were drafted. The final version of statements was subsequently achieved by e-mail consensus.
Results Eighty-five papers were used to inform the Panel’s statements even though most of them were of Class IV quality. The statements tackled four main areas: (1) screening of dysphagia: timing and tools; (2) diagnosis of dysphagia: clinical and instrumental detection, severity assessment; (3) dysphagia and QoL: impact and assessment; (4) prognostic value of dysphagia; impact on the outcome and role of associated conditions. Conclusions The statements elaborated by the Consensus Panel provide a framework to guide the neurologist in the timely detection and accurate diagnosis of dysphagia in PD. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10739-8.
Collapse
|
15
|
Rozas NS, Tribble GD, Jeter CB. Oral Factors That Impact the Oral Microbiota in Parkinson's Disease. Microorganisms 2021; 9:microorganisms9081616. [PMID: 34442695 PMCID: PMC8402101 DOI: 10.3390/microorganisms9081616] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 07/22/2021] [Accepted: 07/26/2021] [Indexed: 01/03/2023] Open
Abstract
Patients with Parkinson’s disease (PD) are at increased risk of aspiration pneumonia, their primary cause of death. Their oral microbiota differs from healthy controls, exacerbating this risk. Our goal was to explore if poor oral health, poor oral hygiene, and dysphagia status affect the oral microbiota composition of these patients. In this cross-sectional case-control study, the oral microbiota from hard and soft tissues of patients with PD (n = 30) and age-, gender-, and education-matched healthy controls (n = 30) was compared using 16S rRNA gene sequencing for bacterial identification. Study participants completed dietary, oral hygiene, drooling, and dysphagia questionnaires, and an oral health screening. Significant differences in soft tissue beta-diversity (p < 0.005) were found, and a higher abundance of opportunistic oral pathogens was detected in patients with PD. Factors that significantly influenced soft tissue beta-diversity and microbiota composition include dysphagia, drooling (both p < 0.05), and salivary pH (p < 0.005). Thus, patients with PD show significant differences in their oral microbiota compared to the controls, which may be due, in part, to dysphagia, drooling, and salivary pH. Understanding factors that alter their oral microbiota could lead to the development of diagnostic and treatment strategies that improve the quality of life and survivability of these patients.
Collapse
Affiliation(s)
- Natalia S. Rozas
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston (UTHealth), 7500 Cambridge St., Suite 5371, Houston, TX 77054, USA;
| | - Gena D. Tribble
- Department of Periodontics and Dental Hygiene, School of Dentistry, The University of Texas Health Science Center at Houston (UTHealth), 1941 East Road, BBS-5318, Houston, TX 77054, USA;
| | - Cameron B. Jeter
- Department of Diagnostic and Biomedical Sciences, School of Dentistry, The University of Texas Health Science Center at Houston (UTHealth), 7500 Cambridge St., Suite 5371, Houston, TX 77054, USA;
- Correspondence: ; Tel.: +1-(713)-486-4427
| |
Collapse
|
16
|
Ortiz Pérez P, Valero Arredondo I, Torcuato Rubio E, Rosa López A, García-Herrera Taillifer P, Navas-López VM. [Clinicopathological characterization of children with dysphagia, family impact and health-related quality of life of their caregivers]. An Pediatr (Barc) 2021; 96:S1695-4033(21)00219-8. [PMID: 34257061 DOI: 10.1016/j.anpedi.2021.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/04/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Oropharyngeal dysphagia (DOF) without proper evaluation can be underdiagnosed in certain groups of the pediatric population. Meeting the needs of these patients can lead to an overload of their caregivers. OBJECTIVES To describe the epidemiological and clinical characteristics of the patients evaluated after starting a monographic DOF clinic (C-DOF) and study whether there are changes at the nutritional level, as well as the burden and impact that caregivers find on quality of life related to health (HRQOL). MATERIAL AND METHODS Descriptive observational study of patients evaluated in a C-DOF from its start-up. To evaluate HRQOL, an ad hoc survey adapted from the Swallowing Quality of Life Questionnaire of the adult population was designed. RESULTS 103 patients were evaluated, 85.4% presenting some neurological disease. A videofluoroscopic study was performed in 51 patients (49.5%), reporting combined alterations in both the oral and pharyngeal phases in 64.7% of them. There was a directly proportional correlation between the severity of the DOF and the presence of aspirations, as well as with the patient's motor impairment. Regarding the anthropometric evaluation, there was a trend toward improvement in weight z-score (+0.14 SD), height (+0.17 SD) and BMI (+0.16 SD). Out of 46.2% of the caregivers reported that the DOF problem interfered negatively in the basic activities of daily life. The increase in HRQOL, after the evaluation in the monographic DOF clinic, was statistically significant overall. CONCLUSIONS The monographic DOF clinic provided specialized care, impacting positively at the nutritional status of patients, as well as perceived changes in HRQOL, with a probable impact on caregivers.
Collapse
Affiliation(s)
- Pilar Ortiz Pérez
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España.
| | - Inés Valero Arredondo
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España
| | - Encarnación Torcuato Rubio
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España
| | - Andrés Rosa López
- Sección de Radiología Pediátrica, Hospital Regional Universitario de Málaga, Málaga, España
| | | | - Víctor Manuel Navas-López
- Sección de Gastroenterología y Nutrición Infantil, Hospital Regional Universitario de Málaga, Málaga, España
| |
Collapse
|
17
|
Zimmerman AS, Shune S, Smith KG, Estis JM, Garand KL. Comparison of Patient-Reported and Caregiver-Reported Swallowing-Related Quality of Life in Parkinson's Disease. Dysphagia 2021; 37:436-445. [PMID: 33846834 DOI: 10.1007/s00455-021-10301-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
This pilot study explored agreement on swallowing-related quality-of-life scores reported by individuals with Parkinson's disease (PD) and their caregivers. Thirty-six patient-caregiver pairs completed the Swallowing Quality of Life Questionnaire (SWAL-QOL) using an online survey format. Additional background and clinical information was ascertained. A Wilcoxon signed-rank test was completed to compare the means of scores between individuals with PD and caregivers. Factors potentially influencing SWAL-QOL scores (age, employment status, sex, ethnicity, race, previous history of swallowing evaluation or treatment, caregiver concern about patient cognition, caregiver burden, and time since onset of disease) were explored using Spearman Coefficient Correlation tests. The Holm-Bonferroni method was used to adjust for multiple comparisons. Results did not reveal significant differences in SWAL-QOL scores between individuals with PD and caregiver pairs. There was a moderate degree of reliability and agreement between paired patient and caregiver scores, with the average ICC measures being 0.598 (95% CI [358, 0.748]) (F(71, 72) = 2.451, p < 0.0001). After adjusting for multiple comparisons, caregiver burden was found to be the only significant factor associated with caregivers' reported scores. No significant influential factor on reported scores by individuals with PD was found. These pilot results suggest individuals with PD and their caregivers may report similar swallowing-related quality-of-life scores. Further, caregiver burden appears to be an influential factor for caregiver-reported scores. Future studies should investigate the clinical benefits of including caregiver SWAL-QOL ratings in assessments, either as a supplement to patient scores to identify discrepancies across the dyad or in place of patient scores if needed. Further, caregiver burden and its influence on dysphagia identification and management should be explored, with targeted interventions to manage caregiver burden.
Collapse
Affiliation(s)
- Allie S Zimmerman
- Department of Speech Pathology and Audiology, University of South Alabama, HAHN 1119, 5721 USA Drive North, Mobile, AL, 36688, USA
| | - Samantha Shune
- College of Education, University of Oregon, 1215 University of Oregon, Eugene, OR, USA
| | - Kimberly G Smith
- Department of Speech Pathology and Audiology, University of South Alabama, HAHN 1119, 5721 USA Drive North, Mobile, AL, 36688, USA
| | - Julie M Estis
- Department of Speech Pathology and Audiology, University of South Alabama, HAHN 1119, 5721 USA Drive North, Mobile, AL, 36688, USA
| | - Kendrea L Garand
- Department of Speech Pathology and Audiology, University of South Alabama, HAHN 1119, 5721 USA Drive North, Mobile, AL, 36688, USA.
| |
Collapse
|
18
|
Rönnefarth M, Hanisch N, Brandt AU, Mähler A, Endres M, Paul F, Doss S. Dysphagia Affecting Quality of Life in Cerebellar Ataxia-a Large Survey. THE CEREBELLUM 2021; 19:437-445. [PMID: 32170655 PMCID: PMC7198478 DOI: 10.1007/s12311-020-01122-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Dysphagia is a common symptom in neurodegenerative disorders and is generally associated with increased mortality. In the clinical care setting of ataxia patients, no systematical and standardized assessment of dysphagia is employed. Its impact on patients’ health-related quality of life is not well understood. To assess the impact of dysphagia in ataxia patients on diet, body weight, and health-related quality of life. We conducted a large survey using self-reported questionnaires for swallowing-related quality of life (Swal-QOL) and a food frequency list in combination with retrospective clinical data of 119 patients with cerebellar ataxia treated in the neurological outpatient clinic of a large German university hospital. Seventeen percent of ataxia patients suffered from dysphagia based on the Swal-QOL score. Less than 1% of all patients reported dysphagia as one of their most disabling symptoms. Dysphagia was associated with unintentional weight loss (p = 0.02) and reduced health-related quality of life (p = 0.01) but did not affect individual nutritional habits (p > 0.05; Chi-squared test). Dysphagia is a relevant symptom in cerebellar ataxia. A systematic screening for dysphagia in patients with cerebellar ataxia would be desirable to enable early diagnosis and treatment.
Collapse
Affiliation(s)
- M Rönnefarth
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - N Hanisch
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - A U Brandt
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - A Mähler
- Experimental & Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
| | - M Endres
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - F Paul
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Experimental & Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Sarah Doss
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Movement Disorders Section, Department of Neurological Sciences, University of Nebraska Medical Center, 4242 Farnam Street, 68131, Omaha, NE, USA.
| |
Collapse
|
19
|
Baert F, Vlaemynck G, Beeckman AS, Van Weyenberg S, Matthys C. Dysphagia management in Parkinson's disease: Comparison of the effect of thickening agents on taste, aroma, and texture. J Food Sci 2021; 86:1039-1047. [PMID: 33521981 DOI: 10.1111/1750-3841.15595] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 12/01/2020] [Accepted: 12/15/2020] [Indexed: 11/27/2022]
Abstract
Dysphagia is a frequent symptom in Parkinson's disease (PD). Thickening liquids facilitates safe swallowing, however, low treatment compliance is a major issue, due to patients' dislike of thickened liquids. Some studies suggest a negative impact of gum-based thickeners, currently most used in clinical practice, on sensory properties compared to starch-based thickeners. This has not yet been investigated in PD. This study's aim was to compare taste, texture, and aroma of gum-based and starch-based thickened soups in participants with PD. Gum-based resource thicken up clear (RTUC) and starch-based kitchen products potato starch (PS) and quinoa flour (QF) were evaluated in broccoli soup. Texture, aroma, and taste were characterized by rheology, volatile, and sensory profiling. Thickened soups were evaluated in participants with PD and controls through a paired comparison test. Reduced release of 61.4%, 46.2%, and 38.5% of volatiles was observed after thickening with RTUC, PS, and QF, respectively. Overall taste intensity was reduced in RTUC- and PS-thickened soup, respectively. Taste and aroma of PS-thickened soup were considered more intense by 70.3% and 63.8% of all participants, respectively (n = 36 PD, n = 41 controls), 56.3% preferred the PS-thickened soup's texture . Taste and aroma of QF-thickened soup were considered more intense by 68.1% and 65.6% of all participants, respectively (n = 47 PD, n = 31 controls), 58.0% preferred the QF-thickened soup's texture. Starch-based thickeners demonstrated higher taste and aroma intensity. However, volatile and sensory profiling demonstrated reduced taste and aroma in all thickeners. Combining kitchen products with flavor enhancers may increase palatability of thickened beverages.
Collapse
Affiliation(s)
- Florence Baert
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Brusselsesteenweg 370, Melle, 9090, Belgium.,Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism, KU Leuven, O&N I Herestraat 49 - box 902, Leuven, 3000, Belgium
| | - Geertrui Vlaemynck
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Brusselsesteenweg 370, Melle, 9090, Belgium
| | - Anne-Sophie Beeckman
- Speech Language Therapy, Postgraduate Course Dysphagia, Artevelde University of Applied Sciences, Campus Kantienberg, Voetweg 66, Gent, 9000, Belgium.,Speech Language Therapy, AZ Maria Middelares, Buitenring Sint-Denijs 30, Gent, 9000, Belgium
| | - Stephanie Van Weyenberg
- Department Technology and Food, Flanders Research Institute for Agriculture, Fisheries and Food, Brusselsesteenweg 370, Melle, 9090, Belgium
| | - Christophe Matthys
- Clinical and Experimental Endocrinology, Department of Chronic Diseases, Metabolism, KU Leuven, O&N I Herestraat 49 - box 902, Leuven, 3000, Belgium.,Department of Endocrinology, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, 3000, Belgium
| |
Collapse
|
20
|
Gastrointestinal Dysfunction in Parkinson's Disease. J Clin Med 2021; 10:jcm10030493. [PMID: 33572547 PMCID: PMC7866791 DOI: 10.3390/jcm10030493] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 12/19/2022] Open
Abstract
Parkinson’s disease (PD) is the second most common neurodegenerative disease. Patients show deposits of pathological, aggregated α-synuclein not only in the brain but throughout almost the entire length of the digestive tract. This gives rise to non-motor symptoms particularly within the gastrointestinal tract and patients experience a wide range of frequent and burdensome symptoms such as dysphagia, bloating, and constipation. Recent evidence suggests that progressive accumulation of gastrointestinal pathology is underway several years before a clinical diagnosis of PD. Notably, constipation has been shown to increase the risk of developing PD and in contrast, truncal vagotomy seems to decrease the risk of PD. Animal models have demonstrated gut-to-brain spreading of pathological α-synuclein and it is currently being intensely studied whether PD begins in the gut of some patients. Gastrointestinal symptoms in PD have been investigated by the use of several different questionnaires. However, there is limited correspondence between subjective gastrointestinal symptoms and objective dysfunction along the gastrointestinal tract, and often the magnitude of dysfunction is underestimated by the use of questionnaires. Therefore, objective measures are important tools to clarify the degree of dysfunction in future studies of PD. Here, we summarize the types and prevalence of subjective gastrointestinal symptoms and objective dysfunction in PD. The potential importance of the gastrointestinal tract in the etiopathogenesis of PD is briefly discussed.
Collapse
|
21
|
Dantas RO, Nascimento WV. Brazilian manuscripts published in the Dysphagia journal. REVISTA CEFAC 2021. [DOI: 10.1590/1982-0216/20212320821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to survey the Brazilian participation in original and review articles published in the Dysphagia journal. Methods: original and review articles in volumes 1 to 35, quantifying all those developed in Brazil, the diseases researched, the places where the investigations were conducted, and the number of citations they received, were analyzed. The categorical variables are presented in relative and absolute frequencies. Literature Review: a total of 35 Brazilian manuscripts were published. The most researched disease was Parkinson’s, followed by Chagas disease, stroke, and the physiology of swallowing. The highest number of publications was carried out at the Universidade de São Paulo, campus at Ribeirão Preto, SP, and the Universidade Federal de São Paulo, capital city. Between 2001 and 2010, 14 manuscripts were published (3.7% of the journal), and between 2011 and 2020, 20 were published (2.9% of the journal). By 2019, the manuscripts had received 481 citations - 17 citations per article between 1998 and 2009, and 14, between 2010 and 2019. Conclusion: Brazilian manuscripts are regularly published in the Dysphagia journal and have a scientific impact. However, there has not been a progressive increase in the number of published articles.
Collapse
|
22
|
A new swallowing supplement for dysphagia in patients with Parkinson's disease. Neurol Sci 2020; 42:1949-1958. [PMID: 32980984 DOI: 10.1007/s10072-020-04730-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
Dysphagia associated with Parkinson's disease (PD) affects the mortality and quality of life of patients with PD. Avoiding aspiration and maintaining swallowing ability are among the concerns regarding PD care. Therefore, we developed a swallowing supplement for easier swallowing and tolerability in patients with PD. Thirty patients with PD and 50 healthy controls were enrolled and their swallowing function measured using the videofluoroscopic swallowing study (VFSS) and several dysphagia scales. The Unified Parkinson's Disease Rating Scale motor scores, Hoehn and Yahr stage, and levodopa doses were evaluated in patients with PD. The VFSS and survey were used to assess the viscosity, color, taste, nutrition, safety, and tolerability of the swallowing supplement. The MMSE score, serum albumin, and hemoglobin levels, and oral conditions were worse in the PD group than in the control group. Compared with controls, patients with PD had significantly lower total and sub-item scores of the swallowing quality of life (swal-QoL). Using commercialized yogurt, the pharyngeal delay time (PDT) and the modified penetration aspiration scale were higher in the PD group than in the control group. The swallowing supplement significantly shortened the PDT and pharyngeal transit time (PTT). Moreover, compared with commercialized yogurt, it improved pharyngeal wall coating, PTT, and aspiration in the videofluoroscopic dysphagia subscales. The survey scores were above average to good in the "easy swallowing" and "pharyngeal residual sense" items and tolerable in the remaining 6 preference items. This swallowing supplement could prevent aspiration and dysphagia complications in patients with PD.
Collapse
|
23
|
Nam S, Shune SE. Behavioral Mimicry as a Strategy to Increase Drinking Behaviors in Older Adults. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2020; 29:1640-1649. [PMID: 32579857 DOI: 10.1044/2020_ajslp-19-00184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Purpose Individuals with dysphagia, particularly in the presence of dementia, are at high risk for decreased nutrition and hydration. Unfortunately, current treatment options are not without limitations and often ignore the crucial social aspects of mealtimes. The aim of this exploratory, proof-of-concept study was to examine whether the social phenomenon of nonconscious behavioral mimicry can increase drinking behaviors in healthy older adults. Method Forty-two older adults (M age = 68.26 years, SD = 6.49) participated. Participants and a member of the research team posing as another participant (a confederate) took turns describing two series of pictures, while, unbeknownst to the participants, the confederate either frequently drank from a cup of water or touched the cup. The primary outcome measures (number of drinks per minute, number of cup touches per minute, percentage of time spent drinking, and percentage of time spent touching the cup) were coded and analyzed across both the confederate drinking and cup-touching conditions. Results Participants drank more frequently and spent more task time drinking during the confederate drinking condition as compared to the cup-touching condition. There was significant variability in drinking patterns across participants, with some only drinking when they were not engaged in the picture description task. Conclusions Behavioral mimicry may increase drinking behaviors in healthy older adults, although the effect may not be as robust among certain subsets of individuals. Clinically, mimicry may hold potential as a powerful, noninvasive supplemental mealtime strategy for increasing intake in those who are most at risk for malnutrition.
Collapse
Affiliation(s)
- Susie Nam
- Communication Disorders and Sciences, University of Oregon, Eugene
- Keck Medical Center of USC, Los Angeles, CA
| | - Samantha E Shune
- Communication Disorders and Sciences, University of Oregon, Eugene
| |
Collapse
|
24
|
Chan HF, Ng ML, Kim H, Kim DY. Swallowing-related quality of life among oral-feeding Chinese patients with Parkinson's disease - a preliminary study using Chinese SWAL-QOL. Disabil Rehabil 2020; 44:1077-1083. [PMID: 32703037 DOI: 10.1080/09638288.2020.1791979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE The objective of the present study is to evaluate swallowing-related quality of life in Chinese patients with Parkinson's disease (PD) using the validated Chinese version of the Swallowing Quality-of-Life Questionnaire (C-SWAL-QOL) and factors associated with swallowing-related quality of life, including age, disease duration, and severity of depression by 15-item Geriatric Depression Scale in Chinese version (GDS-C). METHODS C-SWAL-QOL was administered to 67 Chinese patients with PD. Upon completion of C-SWAL-QOL, they completed the 15-item GDS-C. Spearman's Rho correlation analyses were performed to examine the relationship between the 10-subscale scores of C-SWAL-QOL and (1) age, (2) disease duration, and (3) depression. RESULTS Among the subscales in C-SWAL-QOL, sleep, fatigue, eating duration, and communication were the most severely affected. Significant relationships existed between composite C-SWAL-QOL score, total C-SWAL-QOL score, Dysphagia Symptom Battery (DSB) core, and depression. Significant relationships were also observed between depression and the following subscales: communication, fear, mental health, social functioning, and fatigue. Yet, no relationships existed between score of C-SWAL-QOL and age or disease duration in PD. CONCLUSIONS Considering the goal of dysphagia intervention is to improve swallowing safety and efficiency and ultimately enhance patients' QOL, clinicians should consider using C-SWAL-QOL in clinical practice to measure swallowing outcomes and to better understand treatment effectiveness.Implications for rehabilitationDysphagia-related patient-reported outcome (PRO) measures such as Swallowing Quality-of-Life Questionnaire (SWAL-QOL) are the cornerstone to systematically collecting patient-centered data and monitoring rehabilitation outcomes.Based on the scores of Chinese Parkinson's disease (PD) patients in an oral feeding population indicated in the current study, treatment goal and rehabilitation plan can be set.Chinese patients with Parkinson's disease might benefit from a rehabilitation program focusing on the most severely affected subscales in C-SWAL-QOL.
Collapse
Affiliation(s)
- Hiu Fung Chan
- Speech Science Laboratory, Faculty of Education, University of Hong Kong, Hong Kong, China
| | - Manwa Lawrence Ng
- Speech Science Laboratory, Faculty of Education, University of Hong Kong, Hong Kong, China
| | - HyangHee Kim
- Department and Research Institute of Rehabilitation Medicine, Graduate Program in Speech-Language Pathology, Yonsei University College of Medicine, Seoul, South Korea
| | - Deog Young Kim
- Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, South Korea
| |
Collapse
|
25
|
A Stepwise, Mixed-Method Study Approach to Identify the Barriers to Dysphagia Care in Hospice Care Nurses. J Hosp Palliat Nurs 2019; 20:88-94. [PMID: 30063619 DOI: 10.1097/njh.0000000000000404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dysphagia is common in palliative patients and worsens quality of life. Nurses are the main provider of dysphagia care. An audit showed poor compliance with dysphagia measures among nurses, but little is known about what the barriers are. We sought to evaluate barriers to dysphagia care among hospice nurses. This was a stepwise, mixed-method study. Baseline knowledge and attitudes were assessed, and a lecture was crafted based on the assessment. The knowledge and attitudes were then reassessed to investigate for any change. A focus group and an open-ended questionnaire were then used to assess for other barriers and for the effectiveness of training. Knowledge scores were low at baseline, and training improved the scores. Nurses cited the lack of time and lack of families' involvement as barriers to dysphagia care. While nurses believed that preventing aspiration is important, they also felt that most patients would refuse a modified diet and that respecting their wishes is important. Most nurses felt that the training increased their ability to care for patients with dysphagia. Our study demonstrated that knowledge deficit was an important barrier in dysphagia care for nurses, and this can be improved with a short training. Even though nurses rightly believed that patients' preferences are important, they struggled with trying to balance these preferences with preventing aspiration. Supporting them in making these decisions, having more time for feeding patients, and involving family members may be important to reduce barriers to care for patients with dysphagia.
Collapse
|
26
|
Pitts LL, Kanadet RM, Hamilton VK, Crimmins SK, Cherney LR. Lingual Pressure Dysfunction Contributes to Reduced Swallowing-Related Quality of Life in Parkinson's Disease. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:2671-2679. [PMID: 31390280 DOI: 10.1044/2019_jslhr-s-18-0366] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Dysphagia in Parkinson's disease (PD) is a major cause of depression and reduced quality of life (QOL). PD-related dysphagia often involves lingual dysfunction and weak pressure generation. The relation of disordered lingual pressure generation to swallowing-related QOL in persons with PD remains unknown. Method Twenty-four persons with idiopathic PD completed the Swallowing Quality of Life (SWAL-QOL) questionnaire and an evaluation of anterior and posterior tongue strength. Peak pressures were compared to age- and sex-matched controls. The magnitude of and latency to peak pressure were explored in relation to SWAL-QOL scores. Results Persons with PD exhibited significant anterior (p = .019) but not posterior (p = .081) lingual weakness compared to controls. Persons with PD and reduced anterior tongue strength (< 42 kPa) reported lower SWAL-QOL total (p = .043), extended eating durations (p = .025), and a reduced desire to eat (p = .020). Prolonged latency to peak anterior pressure in PD inversely correlated with SWAL-QOL total (r = -.750, p < .001) and served as a significant, independent predictor of 67% of the variance in SWAL-QOL total when controlling for age, sex, and disease stage. Conclusion Overall, SWAL-QOL scores declined in the presence of lingual pressure dysfunction. Lingual weakness and prolonged pressure building patterns secondary to PD, especially of the anterior tongue, may represent clinically relevant disruptions to mealtime behaviors that undermine swallowing-related QOL. These preliminary findings support further investigation of lingual pressure patterns in PD to help identify debilitating dysphagia and develop treatment strategies.
Collapse
Affiliation(s)
- Laura L Pitts
- Department of Communication Sciences and Disorders, University of Northern Iowa, Cedar Falls
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Speech-Language Pathology, Shirley Ryan AbilityLab, Chicago, IL
| | - Rene M Kanadet
- Speech-Language Pathology, Shirley Ryan AbilityLab, Chicago, IL
| | | | - Sarah K Crimmins
- Department of Communication Sciences and Disorders, University of Northern Iowa, Cedar Falls
| | - Leora R Cherney
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
- Think + Speak Lab, Shirley Ryan AbilityLab, Chicago, IL
| |
Collapse
|
27
|
Ciucci M, Hoffmeister J, Wheeler-Hegland K. Management of Dysphagia in Acquired and Progressive Neurologic Conditions. Semin Speech Lang 2019; 40:203-212. [PMID: 31158904 DOI: 10.1055/s-0039-1688981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
As the act of deglutition involves much of the central and peripheral nervous systems, neurologic disease can affect swallowing behaviors ranging from mild to profound in severity. The key in working with neurogenic dysphagia is to have a solid foundation in normal swallowing processes, including neural control. Within this framework, then, understanding how the neurologic condition affects neural control will guide hypothesis-based assessment and evidence-based treatment. The purpose of this article is to provide an overview of evaluation and treatment of neurogenic dysphagia in adult populations as well to propose assessment of co-occurring speech, language, and airway compromise. Furthermore, it is vital to be familiar with ethical decision making and end-of-life issues. Continuing education in the form of research articles, conferences, and professional discussion boards is useful in maintaining a high level of service delivery. Whenever possible, an inter- or transdisciplinary approach is recommended.
Collapse
Affiliation(s)
- Michelle Ciucci
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin.,Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Jesse Hoffmeister
- Department of Communication Sciences and Disorders, University of Wisconsin-Madison, Madison, Wisconsin.,Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin-Madison, Madison, Wisconsin
| | - Karen Wheeler-Hegland
- Department of Speech, Language and Hearing Sciences, University of Florida, Gainesville, Florida
| |
Collapse
|
28
|
Yi YG, Oh BM, Seo HG, Shin HI, Bang MS. Dysphagia-Related Quality of Life in Adults with Cerebral Palsy on Full Oral Diet Without Enteral Nutrition. Dysphagia 2019; 34:201-209. [DOI: 10.1007/s00455-018-09972-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/31/2018] [Indexed: 10/27/2022]
|
29
|
Schiffer BL, Kendall K. Changes in Timing of Swallow Events in Parkinson's Disease. Ann Otol Rhinol Laryngol 2018; 128:22-27. [PMID: 30328706 DOI: 10.1177/0003489418806918] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES: The prevalence of Parkinson's disease (PD) increases as the population ages. Dysphagia and subsequent aspiration pneumonia are common causes of morbidity and mortality in those with PD. To maximize the benefit of swallowing therapy, protocol design should be based on an understanding of the physiologic swallowing deficits present in the PD population. The aim of this study was to compare the timing of swallow events in a cohort of patients with PD with that in normal age-matched control subjects to characterize variations in the coordination of structural displacement and bolus movement that may contribute to dysphagia. METHODS: This retrospective study included 68 adults with diagnoses of PD. Liquid bolus swallows during modified barium swallow studies were analyzed and compared with those from an age- and sex-matched cohort of 48 adults without PD. RESULTS: Patients with PD were significantly slower in initiating and completing airway closure. Hyoid elevation was prolonged in this patient population. CONCLUSIONS: Patients with PD demonstrate slower initiation of airway closure and a delay in relaxation of hyoid elevation during swallow. Delays increased with larger boluses. These findings may be related to impaired pharyngeal sensation and increased muscular rigidity. The results of this study will be helpful in guiding swallow therapy for patients with PD.
Collapse
Affiliation(s)
- Breanne L Schiffer
- 1 Division of Otolaryngology, Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Katherine Kendall
- 1 Division of Otolaryngology, Head & Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA.,2 Voice Disorders Center, University of Utah Healthcare, Salt Lake City, Utah, USA
| |
Collapse
|
30
|
Mao CJ, Xiong YT, Wang F, Yang YP, Yuan W, Zhu C, Chen J, Liu CF. Motor subtypes and other risk factors associated with drooling in Parkinson's disease patients. Acta Neurol Scand 2018; 137:509-514. [PMID: 29315470 DOI: 10.1111/ane.12893] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To explore the relationship between motor subtypes and drooling, and other risk factors associated with drooling in a large cohort of Chinese patients with Parkinson's disease (PD). METHODS A total of 586 PD patients were enrolled in this study. Unified Parkinson's disease rating scale (UPDRS) and Hoehn & Yahr stage (H & Y stage) scale, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Hamilton Rating Scale for Depression-24 item (HRSD), and Mini-Mental State Examination (MMSE) were applied to all subjects. Salivary subscores of UPDRS part II were used to evaluate drooling. Constipation was diagnosed using the Rome III criteria. RESULTS The prevalence of drooling in this cohort is 54.6% (320/586). Non-TD subtype PD patients tend to have higher daily levodopa-equivalent dose (LED), H & Y stage, UPDRS I, UPDRS II, and UPDRS III scores, HRSD score and ESS score, a higher percentage of levodopa treatment, drooling, dyskinesia, and constipation. After adjusting for confounders, non-TD subtype, male sex, UPDRS III score, ESS and PSQI scores, and constipation were still associated with drooling, with corresponding Odds ratios and 95% confidence intervals (95% CIs) were 1.865 (95% CI, 1.137-3.060), 1. 951 (95% CI, 1.326-2.869), 1.024 (95% CI, 1.002-1.046), 1.064 (95% CI, 1.024-1.105), 1.058 (95% CI, 1.000-1.119), and 1.603 (95% CI, 1.092-2.353), respectively. CONCLUSION Drooling is common, even in mild-to-moderate PD patients. PD patients with non-TD subtype are at a higher risk of drooling. Male sex, motor severity, excessive daytime sleepiness, poor nighttime sleep, and constipation are also associated with drooling in patients with PD.
Collapse
Affiliation(s)
- C. J. Mao
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - Y. T. Xiong
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - F. Wang
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience; Soochow University; Suzhou China
| | - Y. P. Yang
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - W. Yuan
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - C. Zhu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - J. Chen
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
| | - C. F. Liu
- Department of Neurology and Suzhou Clinical Research Center of Neurological Disease; The Second Affiliated Hospital of Soochow University; Suzhou China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases and Institute of Neuroscience; Soochow University; Suzhou China
| |
Collapse
|
31
|
Jones E, Speyer R, Kertscher B, Denman D, Swan K, Cordier R. Health-Related Quality of Life and Oropharyngeal Dysphagia: A Systematic Review. Dysphagia 2017; 33:141-172. [DOI: 10.1007/s00455-017-9844-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 08/21/2017] [Indexed: 12/14/2022]
|
32
|
Dysphagia in Parkinson’s Disease. Dysphagia 2017. [DOI: 10.1007/174_2017_118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
33
|
Sundstedt S, Nordh E, Linder J, Hedström J, Finizia C, Olofsson K. Swallowing Quality of Life After Zona Incerta Deep Brain Stimulation. Ann Otol Rhinol Laryngol 2016; 126:110-116. [PMID: 27831516 DOI: 10.1177/0003489416675874] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The management of Parkinson's disease (PD) has been improved, but management of signs like swallowing problems is still challenging. Deep brain stimulation (DBS) alleviates the cardinal motor symptoms and improves quality of life, but its effect on swallowing is not fully explored. The purpose of this study was to examine self-reported swallowing-specific quality of life before and after caudal zona incerta DBS (cZI DBS) in comparison with a control group. METHODS Nine PD patients (2 women and 7 men) completed the self-report Swallowing Quality of Life questionnaire (SWAL-QOL) before and 12 months after cZI DBS surgery. The postoperative data were compared to 9 controls. Median ages were 53 years (range, 40-70 years) for patients and 54 years (range, 42-72 years) for controls. RESULTS No significant differences were found between the pre- or postoperative scores. The SWAL-QOL total scores did not differ significantly between PD patients and controls. The PD patients reported significantly lower scores in the burden subscale and the symptom scale. CONCLUSIONS Patients with PD selected for cZI DBS showed good self-reported swallowing-specific quality of life, in many aspects equal to controls. The cZI DBS did not negatively affect swallowing-specific quality of life in this study.
Collapse
Affiliation(s)
- Stina Sundstedt
- 1 Department of Clinical Sciences, Division of Otorhinolaryngology, Umeå University, Sweden
| | - Erik Nordh
- 2 Department of Pharmacology and Clinical Neurosciences, Division Neurophysiology, Umeå University, Sweden
| | - Jan Linder
- 3 Department of Pharmacology and Clinical Neurosciences, Division of Neurology, Umeå University, Sweden
| | - Johanna Hedström
- 4 Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Caterina Finizia
- 4 Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden
| | - Katarina Olofsson
- 1 Department of Clinical Sciences, Division of Otorhinolaryngology, Umeå University, Sweden
| |
Collapse
|
34
|
Mukherjee A, Biswas A, Das SK. Gut dysfunction in Parkinson's disease. World J Gastroenterol 2016; 22:5742-5752. [PMID: 27433087 PMCID: PMC4932209 DOI: 10.3748/wjg.v22.i25.5742] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 05/30/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
Early involvement of gut is observed in Parkinson’s disease (PD) and symptoms such as constipation may precede motor symptoms. α-Synuclein pathology is extensively evident in the gut and appears to follow a rostrocaudal gradient. The gut may act as the starting point of PD pathology with spread toward the central nervous system. This spread of the synuclein pathology raises the possibility of prion-like propagation in PD pathogenesis. Recently, the role of gut microbiota in PD pathogenesis has received attention and some phenotypic correlation has also been shown. The extensive involvement of the gut in PD even in its early stages has led to the evaluation of enteric α-synuclein as a possible biomarker of early PD. The clinical manifestations of gastrointestinal dysfunction in PD include malnutrition, oral and dental disorders, sialorrhea, dysphagia, gastroparesis, constipation, and defecatory dysfunction. These conditions are quite distressing for the patients and require relevant investigations and adequate management. Treatment usually involves both pharmacological and non-pharmacological measures. One important aspect of gut dysfunction is its contribution to the clinical fluctuations in PD. Dysphagia and gastroparesis lead to inadequate absorption of oral anti-PD medications. These lead to response fluctuations, particularly delayed-on and no-on, and there is significant relationship between levodopa pharmacokinetics and gastric emptying in patients with PD. Therefore, in such cases, alternative routes of administration or drug delivery systems may be required.
Collapse
|
35
|
van Hooren MRA, Baijens LWJ, Vos R, Pilz W, Kuijpers LMF, Kremer B, Michou E. Voice- and swallow-related quality of life in idiopathic Parkinson's disease. Laryngoscope 2015; 126:408-14. [DOI: 10.1002/lary.25481] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 05/12/2015] [Accepted: 06/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Michel R. A. van Hooren
- Department of Otorhinolaryngology-Head and Neck Surgery; Maastricht University Medical Center; Maastricht the Netherlands
| | - Laura W. J. Baijens
- Department of Otorhinolaryngology-Head and Neck Surgery; Maastricht University Medical Center; Maastricht the Netherlands
| | - Rein Vos
- Department of Methodology and Statistics; CAPHRI School for Public Health and Primary Care, Maastricht University; Maastricht the Netherlands
| | - Walmari Pilz
- Department of Otorhinolaryngology-Head and Neck Surgery; Maastricht University Medical Center; Maastricht the Netherlands
| | - Laura M. F. Kuijpers
- Department of Clinical Sciences; Institute of Tropical Medicine; Antwerp Belgium
| | - Bernd Kremer
- Department of Otorhinolaryngology-Head and Neck Surgery; Maastricht University Medical Center; Maastricht the Netherlands
| | - Emilia Michou
- Centre for Gastrointestinal Sciences; Institute of Inflammation and Repair, University of Manchester, Manchester Academic Health Sciences Centre, Salford Royal Hospital; Salford United Kingdom
| |
Collapse
|
36
|
Paumier KL, Luk KC, Manfredsson FP, Kanaan NM, Lipton JW, Collier TJ, Steece-Collier K, Kemp CJ, Celano S, Schulz E, Sandoval IM, Fleming S, Dirr E, Polinski NK, Trojanowski JQ, Lee VM, Sortwell CE. Intrastriatal injection of pre-formed mouse α-synuclein fibrils into rats triggers α-synuclein pathology and bilateral nigrostriatal degeneration. Neurobiol Dis 2015; 82:185-199. [PMID: 26093169 DOI: 10.1016/j.nbd.2015.06.003] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 12/15/2022] Open
Abstract
Previous studies demonstrate that intrastriatal injections of fibrillar alpha-synuclein (α-syn) into mice induce Parkinson's disease (PD)-like Lewy body (LB) pathology formed by aggregated α-syn in anatomically interconnected regions and significant nigrostriatal degeneration. The aim of the current study was to evaluate whether exogenous mouse α-syn pre-formed fibrils (PFF) injected into the striatum of rats would result in accumulation of LB-like intracellular inclusions and nigrostriatal degeneration. Sprague-Dawley rats received unilateral intrastriatal injections of either non-fibrillized recombinant α-syn or PFF mouse α-syn in 1- or 2- sites and were euthanized at 30, 60 or 180 days post-injection (pi). Both non-fibrillized recombinant α-syn and PFF α-syn injections resulted in phosphorylated α-syn intraneuronal accumulations (i.e., diffuse Lewy neurite (LN)- and LB-like inclusions) with significantly greater accumulations following PFF injection. LB-like inclusions were observed in several areas that innervate the striatum, most prominently the frontal and insular cortices, the amygdala, and the substantia nigra pars compacta (SNpc). α-Syn accumulations co-localized with ubiquitin, p62, and were thioflavin-S-positive and proteinase-k resistant, suggesting that PFF-induced pathology exhibits properties similar to human LBs. Although α-syn inclusions within the SNpc remained ipsilateral to striatal injection, we observed bilateral reductions in nigral dopamine neurons at the 180-day time-point in both the 1- and 2-site PFF injection paradigms. PFF injected rats exhibited bilateral reductions in striatal dopaminergic innervation at 60 and 180 days and bilateral decreases in homovanillic acid; however, dopamine reduction was observed only in the striatum ipsilateral to PFF injection. Although the level of dopamine asymmetry in PFF injected rats at 180 days was insufficient to elicit motor deficits in amphetamine-induced rotations or forelimb use in the cylinder task, significant disruption of ultrasonic vocalizations was observed. Taken together, our findings demonstrate that α-syn PFF are sufficient to seed the pathological conversion and propagation of endogenous α-syn to induce a progressive, neurodegenerative model of α-synucleinopathy in rats.
Collapse
Affiliation(s)
- Katrina L Paumier
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA; Mercy Health Hauenstein Neuroscience Medical Center, Grand Rapids, MI, USA.
| | - Kelvin C Luk
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Fredric P Manfredsson
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA; Mercy Health Hauenstein Neuroscience Medical Center, Grand Rapids, MI, USA
| | - Nicholas M Kanaan
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA; Mercy Health Hauenstein Neuroscience Medical Center, Grand Rapids, MI, USA
| | - Jack W Lipton
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA; Mercy Health Hauenstein Neuroscience Medical Center, Grand Rapids, MI, USA
| | - Timothy J Collier
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA; Mercy Health Hauenstein Neuroscience Medical Center, Grand Rapids, MI, USA
| | - Kathy Steece-Collier
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA; Mercy Health Hauenstein Neuroscience Medical Center, Grand Rapids, MI, USA
| | - Christopher J Kemp
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Stephanie Celano
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Emily Schulz
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Ivette M Sandoval
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Sheila Fleming
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Elliott Dirr
- Department of Psychology, University of Cincinnati, Cincinnati, OH, USA
| | - Nicole K Polinski
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA
| | - John Q Trojanowski
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Virginia M Lee
- Center for Neurodegenerative Disease Research, Department of Pathology and Laboratory Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Caryl E Sortwell
- Department of Translational Science and Molecular Medicine, Michigan State University, Grand Rapids, MI, USA; Mercy Health Hauenstein Neuroscience Medical Center, Grand Rapids, MI, USA
| |
Collapse
|